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STATE ID NUMBER 00000023113002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Z) 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(CORPOPATION.INOIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CLARK WELL & EQUIPMENT CO., INS ( 7 O1 FED ( l 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS <br /> 2024 EAST CHARTER WAY STATE ZIP <br /> STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CLARK WELL & EQUIPMENT CO, INC GEORGE M. CLARK <br /> Y <br /> 4TPEET ADDRESS NEAREST CROSS STREET <br /> 2024 EAST CHARTER WAY "B" STREET <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MSILIN3 ADDRESS CITY STATE ZIP <br /> 2024 EAST CHARTER WAY SI CKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-462-7676 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) ANDPHONEW/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> . !�� <br /> GEORGE M. CLARK ( & '7(,9'7k- <br /> j ? CLARK, GEO M 209-477-0909 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAW ( ) 04 OTHER: lCONTAINER NUMBER ONE <br /> S. MANUFACTURER (IF APPROPRIATE); UNK YEAR MFG: C. YEAR INSTALLED 1949 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) <br /> 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( l INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (10-02 NON-VAULTED W+03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL l ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />